The Effects of Medicare’s “In-the-Home” Restriction
on Beneficiaries
By Paul Tobin
As a person living with a spinal cord injury, and the Deputy
Executive Director of the United Spinal Association, I can
attest that wheelchairs play an integral role in assisting
millions of disabled Americans living independently everyday. United Spinal is a national disability advocacy organization
dedicated to enhancing the quality of life for individuals
with spinal cord injury and spinal cord disease by assuring
quality health care, promoting research, and advocating for
civil rights and independence. We understand the important role that
wheelchairs play in empowering Americans with disabilities,
and United Spinal is committed to repealing Medicare’s
unfair coverage and administrative policies relating to power
wheelchairs and scooters. The most discriminatory and archaic
Medicare policy is the “in-the-patient’s-home” restriction,
which severely impedes on the health and independence of people
with disabilities, as it fails to take into account the need
for people to access their physician’s office, pharmacy,
grocery store, bank or place of worship, by confining them
to the four walls of their homes.
The Medicare “in-the-home” language was originally
meant to define durable medical equipment as devices that were
provided outside of an institution such as a hospital or skilled
nursing facility, and therefore, warranted separate reimbursement
under Medicare Part B. Instead, the Center for Medicare and
Medicaid Services (CMS) chooses to interpret “in-the-home” as
a restriction in coverage to power wheelchairs and scooters
that are considered reasonable and necessary only in the beneficiary’s
home. In other words, beneficiaries who need a wheelchair to
function outside of their home are denied access to the appropriate
and necessary technology essential for achieving independence,
freedom and community integration.
In
recent months, CMS indicated a shift in coverage policy from
the current “bed or
chair confined” criterion to a functional based criteria.
While this is generally a laudable improvement, any functional
assessment of a patient will be incomplete if that assessment
is limited to a beneficiary’s functions inside of their
home. Unless new coverage guidelines reflect a beneficiary’s
functional needs outside of the home, any new coverage
guidelines CMS may choose to adopt are irrelevant. Access
will continue to be denied at the primary level, and people
with disabilities will continue as prisoners in their homes.
CMS’ continued refusal
to address the “in-the-home” restriction represents
an enormous missed opportunity. Despite demands for greater
independence from beneficiaries, advocates, clinicians, providers
and even the Administration, by way of the New Freedom Initiative,
Federal programs such as Ticket to Work and the U.S. Supreme
Court Olmsted decision, CMS appears intent on maintaining
a rule that keeps people with disabilities confined to their
homes. It is counterproductive and hypocritical to promote
independent living and encourage return to work, but then
deny people the appropriate technology necessary for carrying
out these activities under the “in-the-home” restriction.#
Paul
J. Tobin, Deputy Executive Director of United Spinal Association,
holds a degree in Civil Engineering and earned a commission in the
United States Navy in 1991. Duty stations included the
Naval Training Center in Orlando, Florida, and the Naval
Air Warfare Center in Lakehurst, New Jersey, where he served
as Assistant Resident Officer In Charge of Construction.
Tobin sustained a spinal cord injury in August 1993 and,
after rehabilitation, he joined United Spinal’s Board
of Directors, serving from 1995 to 1996. Prior to becoming
Deputy Executive Director, Tobin served as the organization’s
Hospital Services Officer, Director of Special Projects,
Group Director of Benefit Services and Associate Executive
Director of Benefit Services.
